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Medicare Supplemental Basics

As one becomes eligible for Medicare, get ready to be bombarded with information and options. It is very easy to become confused and there is a good chance that the plan you choose will not work as you thought. Basically, there are two categories of Medicare supplemental coverage…traditional (AKA Medigap, Tie-In, Supplement) and Medicare Advantage (AKA MA, MAPD, Part C).

Traditional plans work with your Medicare parts A & B. Medicare is the primary and the supplement is secondary. They work together to pay either all or a portion of the claim dependent upon which plan you choose. The supplement options that are available are plans A, B, C, D, F, G, K, L, M, and N. Under this scenario, these plans basically cover medical claims only and you will need to have a separate prescription plan (AKA part D) for your medications that are taken on a regular basis.

Medicare Advantage plans work differently than traditional plans. In this scenario, Medicare is not part of the claim process. A private insurer is solely responsible for your coverage. The plans available are HMO, PPO, PFFS, and SNP. In most cases, these plans provide both medical and prescription coverage under a single plan.

If a separate prescription plan is needed, the best way to determine the plan that is right for you is by looking up your prescriptions on each company’s formulary. There is not a one size fits all, because each plan has different premiums, co-pays, and formularies.

Enrollment into one of these plans are dependent upon your status…there are several periods where changes can be made to your current plan (which is set by CMS). These are IEP, SEP, AEP, ICEP, OEPI, and MADP.

Again, as you can see, it is easy to become overwhelmed as to what choice to make. We are experts in explaining the different options and can help you feel comfortable with your decision.